[High urinary diversion after irradiation to the lesser pelvis]

Area of Science:

• Urology
• Radiation Oncology

Background:

• Radiotherapy, while essential for cancer treatment, can lead to irreversible long-term adverse effects, notably loss of bladder function.
• Damage often extends to the small bowel, sigmoid, rectum, and ureter, with severity dependent on radiation area, dose, and application quality.

Purpose of the Study:

• To outline essential factors in selecting appropriate urinary diversion techniques following radiotherapy.
• To describe optimal surgical approaches for both continent and incontinent urinary diversions.

Main Methods:

• Review of established surgical techniques for urinary diversion.
• Analysis of factors influencing the choice of diversion: ureter length, bowel segment location relative to radiation fields, and diversion type.

Main Results:

• Continent diversion is best achieved using ascending-transverse or transverse-descending colon pouches with umbilical stoma.
• Incontinent diversion can utilize a simple conduit with the ascending or right colon flexure.
• Transverse conduits are ideal when ureter length is insufficient, allowing bilateral renal pelvis connection and flexible stoma placement.

Conclusions:

• The choice of urinary diversion hinges on ureter length, radiation field proximity, and desired continence.
• Specific colon segments and conduit types offer tailored solutions for complex post-radiotherapy urinary reconstruction.
• Avoiding double stomas in exenteration cases simplifies post-operative management.